Disparities in US Life Expectancy Loom

A man in Fairfax County, Virginia, can expect to live 15 years longer than one in Holmes County, Mississippi, according to a study released today that illuminates health disparities across the United States.

A woman in Collier County, Florida, has 12 years on a woman in Holmes, in the Mississippi Delta region of the southern state, said researchers at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. The study examined life expectancy in 3,147 U.S. counties through 2007.

Tobacco use, obesity, and high blood pressure have dropped life expectancy in Appalachia, the Deep South and northern Texas, said Christopher Murray, the institute director and a report author. He called for more investment in public health programs and increased emphasis on primary care so doctors can catch and control high blood pressure and cholesterol levels.

“Eighty-five percent of counties in the United States are not keeping up with what’s possible for women, and 81 percent of counties in the United States are not keeping up for men,” Murray said in a telephone interview. He defined “what’s possible” as progress made in the top 10 countries, including Canada, Australia, and Japan, in extending human lifespan.

“It’s an achievable thing, to do better,” Murray said. “The question is: what can we do to reorient our medical care system and public health to get better outcomes?”

Health Spending

While the United States spends more per capita on medical care than any other nation, it lags more than 30 others in life expectancy, said the report, which was done in collaboration with Imperial College London. More than $2.3 trillion was paid out for healthcare in 2008, or about $7,681 per resident, according to the Kaiser Family Foundation, a research group in Menlo Park, California.

Before the University of Washington report, the most recent available county data were from 1999, the researchers said.

“The first step for getting more effective primary care and public health programs is to get local ownership of the problem,” Murray said. “People need to know they’re not doing that well. It’s easy to keep doing the same things if you don’t have a benchmark.”

In Holmes, Mississippi, men are expected to live to 65.9 years, and women, to 73.5, the study shows. That compares with 81.1 years for men in Fairfax, Virginia, near Washington, D.C., and 86 years for women in Collier, in the southwest part of Florida, the longest in the country.

Highest Achievers

Counties in the northern Plains and on the East and West Coasts saw the highest life expectancies, the study showed. Overall, life expectancy at birth in 2007 was 75.6 years for men and 80.8 years for women. The United States lags the top 10 countries in life expectancy by 3.2 years, according to the report.

Between 1987 and 2007, life expectancy increased by 4.3 years for men and 2.4 years for women, the study showed. Some counties, such as La Paz in Arizona, saw expected life spans shrink in that time.

Changes in life expectancy have been particularly poor for women, Murray said. Between 2000 and 2007, 661 U.S. counties for men fell more than five years behind the 10 best-performing nations, compared with 1,373 for women, the report showed.

“It’s pretty dramatically worse for women,” he said.

The institute will next track specific causes of death to the county level, Murray said. Focusing on preventable causes of death, such as tobacco use, obesity, blood pressure, and modifiable parts of the diet will help lead to improvements in life expectancy, he said.

“These are major risks that account for a huge part of the pattern we see, and for which there are known primary care or public health strategies that can be used,” Murray said.

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